Provider Demographics
NPI:1932184553
Name:WRIGHTNOUR, JEAN A (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:A
Last Name:WRIGHTNOUR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W PROSPECT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5864
Mailing Address - Country:US
Mailing Address - Phone:440-992-9416
Mailing Address - Fax:440-992-4987
Practice Address - Street 1:517 W PROSPECT RD
Practice Address - Street 2:SUITE B
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5864
Practice Address - Country:US
Practice Address - Phone:440-992-9416
Practice Address - Fax:440-992-4987
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4064/T709152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH045874001OtherDMERC
OH0714614Medicaid
OH0714614Medicaid
0619451Medicare PIN